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Background: Age-related declines in olfaction contribute to low quality of life and appear to occur with declines in cognitive function, including diminished episodic memory. We tested the hypothesis that low gray matter volume within cortical regions that support olfaction and episodic memory can explain age-related differences in olfactory and episodic memory functions., Methods: T1-weighted images, Sniffin' Sticks olfactory measures, and the NIH Toolbox-Cognition Battery were administered to 131 middle-aged to older adults (50-86 years; 66% female). Correlation was used to examine the associations between these measures. A network-based image processing approach was then used to examine the degree to which spatial patterns of gray matter variance were related to the olfactory and cognitive measures. Structural equation modeling was used to characterize the relative specificity of olfactory, cognitive, gray matter, and aging associations., Results: Olfactory threshold, discrimination, and identification exhibited small to medium effect size associations with episodic memory performance (rs = 0.27-0.42, ps < 0.002). Gray matter volume within medial temporal and orbitofrontal cortex was also related to olfactory (discrimination and identification) and episodic memory function (rs = 0.21-0.36, ps < 0.019). Age and episodic memory explained the same variance in olfaction that was explained by the medial temporal and orbitofrontal pattern of gray matter volume., Conclusions: The results of this cross-sectional study suggest that identifying mechanisms contributing to differences in medial temporal and orbitofrontal cortex will advance our understanding of co-morbid olfactory and cognitive declines., (© 2023 ARS‐AAOA, LLC.)

Introduction: Patients often describe the olfactory loss as either the inability to detect unpleasant odors (eg, smoke or spoiled food) or noticeable impairment in enjoying pleasant odors (eg, food and fragrances). This complex relationship between the hedonics of various odors, their perceived magnitude in odor strength, and the impact on patient quality of life is not well understood., Methods: Sixty-five subjects underwent testing with the Henkin olfaction test which assesses hedonics and magnitude for odors traditionally deemed unpleasant (pyridine/dead fish and thiophene/gasoline) and pleasant (amyl acetate/banana and nitrobenzene/almond). Subjects also completed Smell Identification Test-40 (SIT-40), Sniffin' Sticks (Sniffin' Sticks), and Snap & Sniffin' Sticks (Snap) Olfactory Tests, as well as the 17-item Questionnaire for Olfactory Disorders Negative Statements (QODNS) and olfactory symptom visual analog scale (VAS). Spearman's rank correlations were conducted between various olfactory domains, QODNS and VAS., Results: Mean age was 52.1 years (range: 28-86), with 63.1% females. Magnitude estimation was greatest for pyridine. Most people rated thiophene (75.4%) and pyridine (92.3%) as "unpleasant." Although most people rated amyl acetate (47.7%) and nitrobenzene (56.9%) as "pleasant," many rated amyl acetate (52.3%) and nitrobenzene (43.1%) as "neutral" or "unpleasant" scents. Hedonics for unpleasant odors correlated with each other ( r s  = 0.60), but not with hedonics for pleasant odors. Hedonics for unpleasant odors also correlated with magnitude estimation and other psychophysical tests. These findings were not seen for hedonics of pleasant odors., Conclusions: The use of unpleasant odors in Henkin testing showed unique relationship patterns with patient-reported outcome measures and validated olfactory tests, which may provide utility in characterizing olfactory dysfunction. The incorporation of more unpleasant odors in current psychophysical olfactory testing may provide enhanced information regarding the patient impact of olfactory dysfunction.

Background: The literature regarding clinical olfaction, olfactory loss, and olfactory dysfunction has expanded rapidly over the past two decades, with an exponential rise in the past year. There is substantial variability in the quality of this literature and a need to consolidate and critically review the evidence. It is with that aim that we have gathered experts from around the world to produce this International Consensus on Allergy and Rhinology: Olfaction (ICAR:O)., Methods: Using previously described methodology, specific topics were developed relating to olfaction. Each topic was assigned a literature review, evidence-based review, or evidence-based review with recommendations format as dictated by available evidence and scope within the ICAR:O document. Following iterative reviews of each topic, the ICAR:O document was integrated and reviewed by all authors for final consensus., Results: The ICAR:O document reviews nearly 100 separate topics within the realm of olfaction, including diagnosis, epidemiology, disease burden, diagnosis, testing, etiology, treatment, and associated pathologies., Conclusion: This critical review of the existing clinical olfaction literature provides much needed insight and clarity into the evaluation, diagnosis, and treatment of patients with olfactory dysfunction, while also clearly delineating gaps in our knowledge and evidence base that we should investigate further., (© 2022 ARS-AAOA, LLC.)

Background: Olfactory dysfunction (OD) is common, affecting an estimated 13 million adults in the United States. Prior studies may underestimate OD prevalence due to use of brief smell identification tests or age-adjusted cutoff values, which concede that it is acceptable for older people to have a decreased sense of smell., Objective: To determine OD prevalence in the healthy community when the goal and expectation is ideal olfactory function, rather than age-based population norms. Secondary goals were to explore factors associated with OD., Methods: Subjects without otolaryngic complaints were recruited from the community surrounding the Medical University of South Carolina. Olfactory-specific information was collected, and olfactory function was assessed using the Sniffin' Sticks test (Burghardt, Wedel, Germany) to measure threshold, discrimination, and identification (TDI). OD was defined as a TDI score < 31. Bivariate analysis and linear regression were used to determine factors associated with OD., Results: In total, 176 subjects were included with mean age of 52 years (range: 20-93), 111 (63%) female, and 127 (72%) white. Mean TDI score was 28.8 (6.9) and OD was present in 94 (53%) subjects. Multivariate linear regression revealed that TDI decreased an average of 1 point every 5 years. TDI was also associated with Mini-Mental Status Examination (MMSE) score, asthma, and gastroesophageal reflux disease. Threshold was associated with age, heart problems, and gastroesophageal reflux disease. Discrimination was associated with age and MMSE scores. Identification was associated with age, heart problems, and anxiety., Conclusions: In a community-based sample, OD affects greater than 50% of subjects. Aging impacts all aspects of olfaction, while the effects of factors such as asthma, MMSE scores, gastroesophageal reflux disease, heart problems, and anxiety may only be evident in specific olfactory subtests.

Background: Patients with chronic rhinosinusitis (CRS) commonly experience both reduced quality of life (QOL) and olfactory dysfunction (OD). Literature on the impacts of appropriate medical therapy (AMT) for CRS on QOL and OD is limited, and the focused design of these studies may limit their applicability to usual clinical practice., Methods: Adults with symptomatic CRS were prospectively enrolled (November 2016 to October 2018) into an observational, multi-institutional study. Individualized AMT was initiated using standard practice according to evidence-based guidelines. Endoscopy examination (Lund-Kennedy), olfactory function (Sniffin' Sticks) testing, and QOL survey responses (22-item Sino-Nasal Outcome Test [SNOT-22], Questionnaire of Olfactory Disorders-Negative Statements [QOD-NS]) were obtained at enrollment and follow-up., Results: Baseline measures demonstrated heterogeneity of QOL and OD. After an average of 7.8 weeks, within-subject median SNOT-22 total improved by 39.5% (n = 39, p < 0.001) relative to baseline, including 50% (p = 0.014) improvement for item #21, "Sense of smell/taste." QOD-NS improvement was also statistically significant (p = 0.044). Sniffin' Sticks score relative improvement of 10.9% (n = 33, p = 0.109) was not statistically significant and lacked correlation with SNOT-22 total scores (R = -0.247, p = 0.165) or QOD-NS total scores (R = -0.016, p = 0.930), but correlated moderately with endoscopy score (R = -0.436, p = 0.018)., Conclusions: Participants with varied impacts of CRS, treated with individualized short-term AMT, demonstrated significant improvements in CRS- and olfactory-specific QOL measures, without corresponding improvement in clinically measured olfactory function. Olfactory function changes moderately correlated with endoscopy score changes, but lacked an association with QOL measurements., (© 2020 ARS-AAOA, LLC.)

Objective: Enhanced odor sensitivity, particularly toward threat-related cues, may be adaptive during periods of danger. Research also suggests that chronic psychological distress may lead to functional changes in the olfactory system that cause heightened sensitivity to odors. Yet, the association between self-reported odor sensitivity, objective odor detection, and affective psychopathology is currently unclear, and research suggests that persons with affective problems may only be sensitive to specific, threat-related odors., Methods: The current study compared adults with self-reported odor sensitivity that was described as functionally impairing (OSI; n = 32) to those who reported odor sensitivity that was non-impairing (OS; n = 17) on affective variables as well as quantitative odor detection., Results: Increased anxiety sensitivity, trait anxiety, depression, and life stress, even while controlling for comorbid anxiety and depressive disorders, was found for OSI compared to OS. While OSI, compared to OS, demonstrated only a trend increase in objective odor detection of a smoke-like, but not rose-like, odor, further analysis revealed that increased detection of that smoke-like odor was positively correlated with anxiety sensitivity., Conclusion: These findings suggest that persons with various forms of psychological distress may find themselves significantly impaired by an intolerance of odors, but that self-reported odor sensitivity does not necessarily relate to enhanced odor detection ability. However, increased sensitivity to a smoke-like odor appears to be associated with sensitivity to aversive anxiogenic stimuli. Implications for the pathophysiology of fear- and anxiety-related disorders are discussed.

Background Retronasal olfaction is important in flavor detection and enjoyment. The ability to identify specific individual retronasal odors may play a role in quality of life for patients with chronic rhinosinusitis (CRS). Objective To identify patterns and improve understanding of retronasal identification of individual odors in CRS patients. Methods Patients diagnosed with CRS underwent retronasal and orthonasal (Sniffin' Sticks) olfactory testing and taste testing (taste strips). Retronasal identification was tested with presentation of flavored powders on the posterior tongue. Retronasal identification for individual odors was compared with results of orthonasal and taste testing. Results Seventy participants were evaluated. Retronasal identification correlated with orthonasal identification and discrimination for most individual odors. Among all patients, cinnamon and apple were identified better retronasally and banana better orthonasally ( P < .05). Anosmics identified retronasal orange, cinnamon, mushroom, coffee, smoked ham, peach, ginger, grape, and cheese more than would be expected by chance for a forced-choice paradigm with 3 distractor items ( P < .05), and this was independent of objective taste function for most odors. Conclusion Retronasal and orthonasal identification of most odors correlate in CRS patients; however, patients with anosmia can still identify certain retronasal odors more often than expected. These odors do not appear to stimulate gustatory pathways and may involve trigeminal stimulation. Understanding preserved retronasal neural stimuli may allow providers to improve eating-related quality of life in these patients.

Background: Olfactory-specific quality of life (QOL) can be measured using the Questionnaire of Olfactory Disorders-Negative Statements (QOD-NS), which examines various aspects of olfactory dysfunction. It is unknown if certain factors of the QOD-NS differentially impact QOL., Methods: Patients with chronic rhinosinusitis (CRS) completed the QOD-NS, 22-item Sino-Nasal Outcome Test (SNOT-22), Medical Outcomes Study Short Form 6-D (SF-6D) health utility measure, and Patient Health Questionnaire-2 (PHQ-2) depression screen. Exploratory factor analysis of the QOD-NS was performed. Associations between QOD-NS factors and other QOL metrics were analyzed before and after endoscopic sinus surgery (ESS)., Results: Outcomes were examined on 132 patients. The QOD-NS contains 4 distinct factors. There was no difference in associations between the different factors and baseline clinical characteristics. ESS had greatest effect size (d) on factors 2 and 4 (d = 0.29 and 0.27, respectively, p < 0.05). Postsurgical changes in the SF-6D and SNOT-22 had the strongest correlation with factor 2 scores (r = 0.29 and 0.34, respectively, p < 0.05), and changes in the PHQ-2 had the strongest correlation to factor 3 (r = 0.24, p < 0.05). Abnormal QOD-NS scores at baseline were associated with effect size increases of 50% to 100% (p < 0.05)., Conclusion: The QOD-NS measures 4 distinct factors. Eating-related questions had the greatest improvement after ESS. Health utility and CRS-specific QOL improvement most strongly associated with factor 2, while PHQ-2 changes are most highly associated with factor 3, suggesting a differential impact of the factors of the QOD-NS on varying aspects of QOL., (© 2018 ARS-AAOA, LLC.)

Background: Commonly used computed tomography (CT) staging systems for chronic rhinosinusitis (CRS) focus on the sinuses and do not quantify disease in the olfactory cleft. The goal of the current study was to determine whether precise measurements of olfactory cleft opacification better correlate with olfaction in patients with CRS., Methods: Olfaction was assessed using the 40-item Smell Identification Test (SIT-40) before and after sinus surgery in adult patients. Olfactory cleft opacification was quantified precisely using three-dimensional (3D), computerized volumetric analysis, as well as via semiquantitative Likert scale estimations at predetermined anatomic sites. Sinus opacification was also quantified using the Lund-Mackay staging system., Results: The overall cohort (n = 199) included 89 (44.7%) patients with CRS with nasal polyposis (CRSwNP) and 110 (55.3%) with CRS without nasal polyposis (CRSsNP). The olfactory cleft opacified volume correlated with objective olfaction as determined by the SIT-40 (Spearman's rank correlation coefficient [Rs ] = -0.461; p < 0.001). The correlation was significantly stronger in the CRSwNP subgroup (Rs = -0.573; p < 0.001), whereas no appreciable correlation was found in the CRSsNP group (Rs = -0.141; p = 0.141). Correlations between sinus-specific Lund-Mackay CT scoring and SIT-40 scores were weaker in the CRSwNP (Rs = -0.377; p < 0.001) subgroup but stronger in the CRSsNP (Rs = -0.225; p = 0.018) group when compared to olfactory cleft correlations. Greater intraclass correlations (ICCs) were found between quantitative volumetric measures of olfactory cleft opacification (ICC = 0.844; p < 0.001) as compared with semiquantitative Likert grading (ICC = 0.627; p < 0.001)., Conclusion: Quantitative measures of olfactory cleft opacification correlate with objective olfaction, with the strongest correlations seen in patients with nasal polyps., (© 2015 ARS-AAOA, LLC.)

Keywords: allergic rhinitis; allergies; anxiety; depression; mood disorders EN allergic rhinitis allergies anxiety depression mood disorders 1489 1491 3 07/26/23 20230801 NES 230801 SUMMARY Our patients today stand at the junction of two worrisome trends: allergy seasons are worsening, and rates of depression and anxiety are rising.[[1], [3]] We may not often think about the relationship between allergic rhinitis (AR) and mood disorders, but their increasing incidence and severity should serve as a reminder of their remarkable association. Allergy treatment can improve symptoms of both allergies and concomitant mood disorders, and simultaneously treating mood disorders with therapy appears to help even more.[28] However, we cannot offer appropriate treatment or referrals if we do not know what our patients experience. Rhinologists should likewise make patients aware of the association between AR and mood disorders and feel comfortable inquiring about such symptoms. Whether by administering validated mood disorder patient-reported outcome instruments, or simply by maintaining open and nonjudgmental inquiry and support for our patients, identifying and addressing concomitant mood disorders facilitates holistic patient care. [Extracted from the article]

Background: Current clinical classifications of olfactory function are based primarily upon a percentage of correct answers in olfactory identification testing. This simple classification provides little insight into etiologies of olfactory loss, associated comorbidities, or impact on the quality of life (QOL). Methods: Community-based subjects underwent olfactory psychophysical testing using Sniffin Sticks to measure threshold (T), discrimination (D), and identification (I). The cognitive screening was performed using Mini-Mental Status Examination (MMSE). Unsupervised clustering was performed based upon T, D, I, and MMSE. Post hoc differences in demographics, comorbidities, and QOL measures were assessed. Results: Clustering of 219 subjects, mean age 51 years (range 20-93 years) resulted in 4 unique clusters. Cluster 1 was the largest and predominantly younger normosmics. Cluster 2 had the worst olfaction with impairment in nearly all aspects of olfaction and decreased MMSE scores. This cluster had higher rates of smoking, heart disease, and cancer and had the worst olfactory-specific QOL. Cluster 3 had normal MMSE with relative preservation of D and I, but severely impaired T. This cluster had higher rates of smoking and heart disease with moderately impaired QOL. Cluster 4 was notable for the worst MMSE scores, but general preservation of D and I with moderate loss of T. This cluster had higher rates of Black subjects, diabetes, and viral/traumatic olfactory loss. Conclusion: Unsupervised clustering based upon detailed olfactory testing and cognitive testing results in clinical phenotypes with unique risk factors and QOL impacts. These clusters may provide additional information regarding etiologies and subsequent therapies to treat olfactory loss. [ABSTRACT FROM AUTHOR]

Background: Dysosmia could alter dietary quality through mechanisms including changes in appetite, food choice, and subsequent nutritional intake. However, there are few studies that directly assess olfactory performance and dietary quality. In this pilot study, we aimed to measure dietary quality in patients with dysosmia compared with controls with normosmia. Methods: Community‐dwelling adults prospectively underwent olfactory testing using the Sniffin' Sticks test from which composite threshold, discrimination, and identification (TDI) scores were used to identify patients with dysosmia (TDI <31) and controls with normosmia (TDI ≥31). Participants completed the Diet History Questionnaire III (DHQ III), a standardized and validated tool for nutritional assessment developed by the National Institutes of Health. The Healthy Eating Index (HEI) was calculated to determine compliance with the US Dietary Guidelines for Americans. Results: Sixty patients were enrolled, including 29 patients with dysosmia and 31 controls with normosmia with no difference in age or sex among groups. A significant correlation between TDI score and HEI component score was seen for protein (r = 0.256; p = 0.048), dairy (r = 0.285; p = 0.027), and saturated fat (r = −0.262; p = 0.043) scores. Compared with controls with normosmia, patients with dysosmia were found to have less total protein and total dairy intake, as well as less total saturated fat intake. Conclusions: This study found significantly altered nutritional quality in patients with reduced olfactory function, including decreased intake of protein, dairy, and saturated fats. These findings are relevant given the high prevalence of dysosmia in the aging population and previous studies showing associations with mortality. [ABSTRACT FROM AUTHOR]

Background: Olfactory dysfunction (OD) is a strong, independent predictor of frailty and mortality risk. This study evaluated the association of dietary patterns and frailty status in older adults with OD. Methods: This cross-sectional study utilized the 2013–2014 National Health and Nutrition Examination Survey. Dietary patterns (DPs) characteristic of OD were derived using exploratory factor analysis (EFA). Multiple logistic regressions adjusted for demographics and frailty risk factors assessed the association of DPs with two frailty metrics: the frailty index (FI) and physical frailty (PF). Results: EFA yielded six distinct DPs in persons with OD. The protein/selenium (OR 0.82 [95% CI 0.74–0.92], p = 0.041) and β-carotene/vitamin A DPs (OR 0.76 [95% CI 0.66–0.88], p = 0.028) were independently associated with frailty by FI. Only the protein/selenium DP (OR 0.82 [95% CI 0.74–0.92], p = 0.036) was associated with frailty by PF. No DPs were associated with either frailty measure in normosmic persons. Conclusions: Dietary patterns high in protein/selenium and β-carotene/vitamin A are associated with lower frailty prevalence in adults with OD. While the relationship between OD and frailty is likely multifaceted, these findings suggest that dietary patterns are uniquely associated with frailty in older adults with OD. [ABSTRACT FROM AUTHOR]

Background: Mechanisms of smell loss in chronic rhinosinusitis (CRS) are still unclear and likely multifactorial. Little attention has been given to olfactory cleft (OC) mucus proteins involved in odorant binding and metabolizing enzymes and their potential role in smell loss. Methods: Mucus from the OC was sampled from patients with CRS (n = 20) and controls (n = 10). Liquid chromatography and mass spectrometry were performed, followed by data processing so that protein groups could be identified, quantified, and compared. Hierarchical clustering and bioinformatic analysis were performed on significantly different proteins to explore for enrichment in known biologic pathways. Results: A total of 2514 proteins were found in OC mucus from all 30 subjects. Significant differences in protein abundance were found between CRS and controls, including both CRSsNP (n = 351 proteins; log2 fold change range: –3.88 to 6.71) and CRSwNP (n = 298 proteins; log2 fold change range: –4.00 to –6.13). Significant differences were found between patients with normosmia and those with dysosmia (n = 183; log2 fold change range: –3.62 to –2.16) and across groups of interest for a number of odorant binding proteins and metabolizing enzymes. Conclusion: OC mucous in CRS displays a rich and abundant array of proteins, many of which have been implicated in odorant transport and metabolization in animal studies. Significant differences in the olfactory mucus proteome were seen between CRS subtypes and controls, as well as between those with normal and abnormal olfaction. Further study should confirm these findings and explore the role individual proteins play in odorant transport and metabolization. ©2020 ARSAAOA, LLC. [ABSTRACT FROM AUTHOR]

Background: Many patients with chronic rhinosinusitis (CRS) have persistent olfactory dysfunction (OD) following endoscopic sinus surgery (ESS). Few studies compare outcomes to control subjects so it is unknown if residual OD is due to persistent CRS. Objective: Compare postoperative measures of OD in case patients with CRS to healthy controls without sinonasal disease. Methods: Prospective, observational, multicenter cohort study between October, 2016 and May, 2019. Case participants were selected from referred adult patients diagnosed with CRS, with or without nasal polyposis (NP), electing ESS as subsequent treatment modality. Controls voluntarily enrolled from a community-based sample without a history of CRS. Primary outcomes included measures of preoperative and postoperative OD using "Sniffin' Stick" pens which summarize odorant threshold (T), discrimination (D), and identification (I) scores. Secondary outcomes included the Questionnaire of Olfactory Disorders-Negative Statements (QOD-NS) survey and olfactory cleft endoscopy scores (OCES). Results: Outcomes were compared between 113 cases and 164 controls of similar average age and gender. Cases reported significantly worse baseline Sniffin' Sticks TDI total scores (−6.8[SE ± 1.0]; 95% CI: −4.9 to −8.7), QOD-NS (8.9[SE ± 1.1]; 95% CI: 6.8–10.9), and OCES (3.5[SE ± 0.4]; 95% CI: 2.9–4.2) on average. Cases reported significant postoperative improvement in TDI total score (3.7[SD ± 8.2]; 95% CI: 2.2–5.2), QOD-NS (−5.9[SD ± 8.7]; 95% CI: −7.6 to −4.3), and OCES (−1.7[SD ± 3.8]; 95% CI: −2.7 to −0.8) on average, while 63% of anosmics reported improved postoperative olfaction. Multivariate regression identified that NP (OR = 0.4; 95% CI: 0.2–1.0) and previous ESS (OR = 0.3; 95% CI: 0.1–0.8) decreased the odds of postoperative improvement equal to mean TDI scores of controls, while septoplasty increased those odds (OR = 4.5; 95% CI: 1.5–13.7). Conclusion: ESS improved olfactory metrics and restored olfactory function in approximately 50% of patients with CRS to that of healthy controls. Concurrent septoplasty increased the likelihood of achieving normal olfaction, while NP and previous ESS decreased those odds. [ABSTRACT FROM AUTHOR]

Background: Olfactory dysfunction (OD) has been reported to impact social interactions. However, the relationship between OD and loneliness has received little attention. The purpose of this study was to determine the association between OD and loneliness, controlling for patient factors. Methods: Subjects without otolaryngic complaints were enrolled and olfactory function was assessed using: Sniffin' Sticks test to measure threshold, discrimination and identification (TDI), Questionnaire of Olfactory Disorders Negative Statements (QOD-NS) and 9 – item Olfactory-Visual Analogue Scale (VAS). Loneliness was assessed using the De Jong Gierveld (DJG) and University of California Los Angeles (UCLA) loneliness scales. Bivariate analysis was performed followed by regression analysis, controlling for confounders. Results: In total, 221 subjects were included with a mean age of 50.5 years (range 20 to 93), 133 (60.2%) females and 161 (72.9%) white. Mean TDI score was 29.3 (7.0) and 49.5% of the cohort was dysosmic. Using DJG, 36.4% of the cohort were classified as lonely, whereas 35.0% were lonely using UCLA. Olfactory measures were significantly associated with DJG, including TDI (β = −0.03, p = 0.050), olfactory discrimination (β = −0.111, p = 0.005), QOD-NS (β = 0.058, p < 0.001) and olfactory-VAS (β = 0.032, p < 0.001). UCLA scores were significantly associated with QOD-NS (PR 1.061 [CI 1.018–1.107], p = 0.005) and olfactory-VAS scores (PR 1.027, [CI 1.007–1.049], p = 0.009). After controlling for confounders, the association between DJG and olfactory discrimination, as well as DJG and olfactory-VAS remained significant. Conclusions: In this community-based sample of older adults, both OD and loneliness were common. Those subjects with worse olfactory function were more likely to report loneliness. Further research is necessary to establish causality, as well as explore the role of depression. [ABSTRACT FROM AUTHOR]

Background: Olfactory dysfunction (OD) is common and has been reported as an early indicator of COVID-19. However, the reported prevalence of OD in the general population varies widely depending upon the metric used to assess olfaction. Methodology/Principal: To perform a systematic review and meta-analysis of the prevalence of OD in the healthy general population, review the various assessment metrics used, and compare pooled OD prevalence rates. Results: A total of 175,073 subjects were identified (mean age 63.5 years, range 18 to 101) with an overall OD prevalence of 22.2% (95% CI 14.8–30.6). OD prevalence was significantly greater using objective olfactory assessments, compared to subjective measures (28.8%, CI 20.3–38.2 versus 9.5%, CI 6.1–13.5, p < 0.001). The prevalence of OD was greater using expanded identification tests (>8 items) compared to brief test with ≤8 items (30.3%, CI 16.2–46.5 versus 21.2%, CI 12.3–31.8). Prevalence was higher in studies with a mean age greater than 55 years compared to those with a mean age of 55 years or less (34.5%, CI 23.4–46.5 versus 7.5%, CI 2.6–14.5, p < 0.001). Conclusions: The reported prevalence of OD in the general population depends on the testing method and population age. OD prevalence was greater in studies using objective tests, expanded identification tests, and in those with older subjects. [ABSTRACT FROM AUTHOR]

Objective: The goals of this study were to assess retronasal olfaction in patients with chronic rhinosinusitis (CRS) and describe clinical factors that influence retronasal olfaction. This study sought to investigate the influence of retronasal olfaction on patient-perceived outcomes and examine the relationship between retronasal and orthonasal olfaction.Methods: Retronasal olfactory function was tested using odorized powders in the oral cavity, whereas Sniffin' Sticks test (Burghart Instruments, Wedel, Germany) were used to assess orthonasal function prospectively in 69 adult CRS patients. Endoscopic evaluation of the olfactory cleft was scored using the Olfactory Cleft Endoscopy Scale (OCES). Several quality-of-life (QOL) instruments relating to sinonasal, olfactory, and chemosensory functions were used to assess the interactions between patient-reported outcome measures and retronasal olfaction.Results: There was strong correlation between retronasal and total orthonasal olfaction scores (r = 0.77, P < 0.001) as well as retronasal scores with orthonasal subscores. Retronasal scores were worse in patients with nasal polyposis (P = 0.002), asthma (P = 0.04), and aspirin-exacerbated respiratory disease (AERD) (P = 0.02), whereas OCES was the only independent predictor of retronasal olfaction (r = -0.42, P < 0.001). Significant correlation existed between retronasal olfaction and olfactory-specific QOL and chemosensory smell scores.Conclusion: Few studies have examined retronasal olfaction in CRS patients. In this cohort, CRS patients demonstrated deficits in retronasal olfaction, with worse scores in patients with nasal polyposis, asthma, and AERD. Retronasal olfaction scores correlate with degree of inflammation of the olfactory cleft. Retronasal olfaction correlated strongly with orthonasal olfaction and patient-reported smell and taste metrics, although orthonasal olfaction may have a stronger correlation with these metrics.Level Of Evidence: NA. Laryngoscope, 2437-2442, 2018. [ABSTRACT FROM AUTHOR]

Background: The association of gustatory dysfunction (GD) with quality of life (QOL) and cognition in older adults is understudied. Our objective was to study the prevalence of GD in the community and explore impacts and associated factors. Methods: A prospective, multi‐institutional, pre‐corona virus disease (COVID) cohort of adults aged 50 years and older had smell and taste testing using "Sniffin' Sticks" (TDI) and "Taste Strips." The impact of GD on mood, QOL, and social interaction was assessed through visual analog scales. Subjects completed the Questionnaire of Olfactory Disorders, Patient Health Questionnaire 9, Mini‐Mental State Examination (MMSE), Montreal Cognitive Assessment, and the DeJong scale of loneliness. Results: A total of 48 patients, average age of 54.7 years, were enrolled. Thirty‐two percent experienced GD on taste strips, and 62% experienced olfactory dysfunction (OD) on TDI. Almost 30% (29.5%) had both GD and OD. GD and OD correlated with worsened cognitive function on MMSE (r = 0.392 and 0.05, p = 0.018 and 0.003). Subjects with both GD and OD had worse MMSE than either alone (p = 0.003). Dry mouth and difficult chewing correlated with GD (r = −0.37 and −0.31, p = 0.10 and 0.37). Self‐reported GD and OD were correlated (r = 0.46, p = 0.001), as were psychophysical GD and OD (r = 0.394, p = 0.008). GD did not correlate with other metrics. Conclusion: Thirty‐two percent of subjects experienced GD on psychophysical testing, yet most are unaware without impacts on daily life. However, GD correlates with worsened cognitive function. Taste testing may play a role in screening of neurocognitive decline, and multisensory dysfunction may indicate of worsened cognitive states. [ABSTRACT FROM AUTHOR]

Objectives: Many studies have reported that olfactory dysfunction frequently occurs in chronic rhinosinusitis (CRS) populations; however, the prevalence and degree of olfactory loss has not been systematically studied. The aims of this study were to use combined data to report the prevalence of olfactory dysfunction and to calculate weighted averages of olfactory test scores in CRS patients.Data Sources: A search was conducted in PubMed and Scopus, following the methods of Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines.Review Methods: Studies reporting the prevalence of olfactory dysfunction using objective measures or olfactory test scores using validated scales were included.Results: A total of 47 articles were included in a systematic review and 35 in the pooled data analysis. The prevalence of olfactory dysfunction in chronic rhinosinusitis was found to be 30.0% using the Brief Smell Identification Test, 67.0% using the 40-item Smell Identification Test, and 78.2% using the total Sniffin' Sticks score. Weighted averages ± standard deviation of olfactory test scores were 25.96 ± 7.11 using the 40-item Smell Identification Test, 8.60 ± 2.81 using the Brief Smell Identification Test, 21.96 ± 8.88 using total Sniffin' Sticks score, 5.65 ± 1.51 using Sniffin' Sticks-Threshold, 9.21 ± 4.63 using Sniffin' Sticks-Discrimination, 9.47 ± 3.92 using Sniffin' Sticks-Identification, and 8.90 ± 5.14 using the Questionnaire for Olfactory Disorders-Negative Statements.Conclusions: In CRS populations, a significant percentage of patients experience olfactory dysfunction, and mean olfactory scores are within the dysosmic range. Laryngoscope, 2016 127:309-320, 2017. [ABSTRACT FROM AUTHOR]

Objective To use combined pre- and postsurgical olfactory outcomes to assess the impact of endoscopic sinus surgery on chronic rhinosinusitis−related olfactory impairment. Data Sources CINAHL, Cochrane, OVID, EMBASE, PubMed, and SCOPUS. Each database was searched from inception up to October 2015. Review Methods Studies were included that reported subjective or objective olfactory data in chronic rhinosinusitis patients before and after endoscopic sinus surgery. Results Thirty-one studies were used in the meta-analysis. Weighted mean differences of olfactory measures demonstrated significant improvement in mixed CRS patients (those with and without polyps) through visual analog scales (−0.83, P = .001), altered taste/smell item on Sinonasal Outcome Test (−1.32, P < .00001), 40-item Smell Identification Test (3.49, P = .0010), and Sniffin’ Sticks identification (0.34, P = .03). Chronic rhinosinusitis mixed patients demonstrated nonsignificant improvements via Sniffin’ Sticks threshold (1.60, P = .16) and Brief Smell Identification Test (0.20, P = .32). When separated, polyp patients and dysosmic patients experienced the highest levels of olfactory improvement. Polyp patients improved by 7.87 (P = .006) on the 40-item Smell Identification test, 11.54 (P < .0001) with the Sniffin’ Sticks total score, and 2.57 (P < .00001) through Sniffin’ Sticks identification. Dysosmic patients improved by 5.75 via the 40-item Smell Identification Test (P = .0001). Conclusion Endoscopic sinus surgery improves nearly all subjective and objective measures of olfaction in chronic rhinosinusitis patients. Patients with nasal polyposis or preoperative olfactory dysfunction improve to a greater degree. [ABSTRACT FROM AUTHOR]

Although chronic rhinosinusitis (CRS) is considered the most treatable form of olfactory dysfunction, there has been relatively little clinical attention focused on assessing endotypes as they pertain to olfactory loss. The goal of this study was to explore inflammatory endotypes in CRS using an unsupervised cluster analysis of olfactory cleft (OC) biomarkers in a phenotype-free approach. Patients with CRS were prospectively recruited and psychophysical olfactory testing, Questionnaire of Olfactory Dysfunction (QOD-NS), and bilateral OC endoscopy were obtained. Mucus was collected from the OC and evaluated for 26 biomarkers using principal component analysis. Cluster analysis was performed using only OC biomarkers and differences in olfactory measures were compared across clusters. A total of 198 subjects (128 with CRS and 70 controls) were evaluated. Evaluation of OC biomarkers indicated 6 principal components, explaining 69.50% of the variance, with type 2, mixed type 1/T h 17-cell, growth factor, and neutrophil chemoattractant inflammatory signatures. A total of 10 clusters were identified that differed significantly in frequency of controls, and subjects with CRS with nasal polyps, and subjects with CRS without nasal polyps across the clusters (likelihood ratio test, χ 18 2 = 178.64 ; P <.001). Olfactory measures differed significantly across clusters, including olfactory testing, QOD-NS, and OC endoscopy (P <.001 for all). Clustering based solely on OC biomarkers can organize patients into clinically meaningful endotypes that discriminate between subjects with CRS and controls. Validation studies are necessary to confirm these findings and further refine olfactory endotypes. [ABSTRACT FROM AUTHOR]

Background: Many studies have identified a higher degree of Olfactory Dysfunction (OD) in Black patients compared to White patients. This study aims to analyze olfactory outcomes in different races. Methods: The PubMed, Scopus, and CINAHL databases were searched from inception to September 5, 2022, for English‐language articles documenting self‐reported and psychophysical OD stratified by race. A meta‐analysis of proportions, comparison of weighted proportions, and comparison of means were performed in MedCalc 20.218. In the quantitative analysis, 79,297 patients were included, comprising 79.3% Whites, 16.1% Blacks, and 4.6% Hispanics. Results: A total of 14 studies were meta‐analyzed. The prevalence of self‐reported OD in Hispanic, White, and Black patients was 19.5% (95% CI, 16.6% to 22.6%), 17.2% (95% CI, 10.5% to 25.0%), and 13.9% (95% CI, 9.3% to 19.2%), respectively (p < 0.0007). The prevalence of psychophysical OD in Black, White, and Hispanic patients was 30.3% (95% CI, 24.2% to 36.9%), 24.2% (95% CI, 20.1% to 28.5%), and 18.4% (95% CI, 16.3% to 20.7%), respectively (p < 0.0001). Blacks reported a greater extent of unrecognized OD compared to Whites, with a difference of 16.5% (95% CI, 15.0% to 17.9%) versus 5.8% (95% CI, 3.4% to 8.0%), respectively (p < 0.0001). Hispanic rates of self‐reported OD and psychophysical OD were not statistically different. Conclusions: Our findings suggest that Blacks have the highest rate of psychophysical OD and are more likely to underreport their awareness compared to Whites. [ABSTRACT FROM AUTHOR]

Background: Chronic rhinosinusitis (CRS) is one of the most common causes of olfactory loss, but the pathophysiology underlying olfactory dysfunction in CRS has not been fully elucidated. Previous studies found correlations between olfactory cleft (OC) inflammatory cytokines/chemokines and olfaction in CRS. The purpose of this study was to evaluate the relationship between OC mucus inflammatory proteins and olfaction in a multi‐institutional cohort. Methods: Adults with CRS were prospectively recruited. Demographics, comorbidities, olfactory assessment (Sniffin' Sticks), computed tomography (CT), and OC mucus for protein analysis were collected. Statistical analysis was performed to determine associations between olfactory function, OC mucus protein concentrations, and CT opacification. Results: Sixty‐two patients were enrolled in the study, with an average age of 48.2 (standard deviation, 16.2) years, and 56.5% were female and 59.7% were classified as CRS with nasal polyps (CRSwNP). Ten of 26 OC mucus proteins were significantly correlated with threshold, discrimination, and identification (TDI) scores and OC opacification. Subgroup analysis by polyp status revealed that, within the CRSwNP group, C‐C motif ligand 2 (CCL2), interleukin‐5 (IL‐5), IL‐6, IL‐13, IL‐10, IL‐9, tumor necrosis factor‐α (TNF‐α), CCL5, and CCL11 were significantly correlated with olfaction. For CRS without nasal polyps (CRSsNP), only C‐X‐C ligand 5 (CXCL5) showed a correlation. In CRSwNP, IL‐6, IL‐10, vascular endothelial growth factor‐A, and immunoglobulin E (IgE) correlated with OC opacification, whereas, in CRSsNP, only CXCL5 showed a correlation. OC mucus proteins and Lund‐Mackay score correlated only in the CRSsNP group (CXCL5, IL‐5, IL‐13, IgE). Conclusion: Several OC mucus proteins have been found to correlate with olfactory function and OC opacification. The profile of OC mucus proteins differs between CRSsNP and CRSwNP subgroups, suggesting different mechanisms between groups, but further study is required. [ABSTRACT FROM AUTHOR]

Background: The Questionnaire of Olfactory Disorders‒Negative Statements (QOD‐NS) is a valuable instrument in the measurement of olfactory‐specific quality of life (QOL). In the clinical setting, patients can be overwhelmed with the time required to complete questionnaires. Our objective was to develop a brief version of the QOD‐NS to streamline clinical care and research. Methods: QOD‐NS scores from 221 subjects were used to determine which subset of the 17 QOD‐NS questions best correlated with total and subdomain QOD‐NS scores. An initial pool of 11 questions was made by removing items with ρ < 0.80 to their respective subdomain scores. Next, 500 bootstrapped samples were taken. On each sampe, an all‐subsets regression was performed with total QOD‐NS scores and QOD‐NS subdomain scores as the outcomes. From this, our "top" and "bottom" 10 subsets were identified based on mean r2 value, representation in bootstrap analysis, and number of items. Results: All of our top subsets had excellent correlation with total and subdomain QOD‐NS scores (mean r2 > 0.90). Our top choice has 7 total questions, is representative of all subdomains, has a mean r2 = 0.92, and was represented in 323 of our 500 bootstrapped samples. The worst‐performing subset has 5 items, mean r2 = 0.81, and was represented in only 1 bootstrapped sample. Conclusions: Using less than half of the questions in the QOD‐NS, excellent correlations with both total and domain‐specific scores are achieved. A brief version of the QOD‐NS may prove useful in future clinical and research settings. [ABSTRACT FROM AUTHOR]

Background: While various sinus computed tomography (CT) scoring systems have been proposed and used in the literature, no single system has been identified as superior. The strength of associations between CT scoring systems and measures of olfaction also remains unclear. Methods: A systematic review of PubMed, CINAHL, Scopus, and the Cochrane Library was conducted following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Studies that reported both CT scores and measures of olfaction in a cross‐sectional manner were included. Results: A total of 37 studies were eligible for meta‐analysis. Of 8035 patients with chronic rhinosinusitis, 55.6% were male patients and 53.2% had chronic rhinosinusitis with nasal polyps. Analysis by meta‐regression was performed of Lund‐Mackay (LM) versus Smell Identification Test‐40 (SIT‐40; 12 studies), Brief Smell Identification Test (BSIT; 10 studies), Sniffin' Sticks (SS; 10 studies), and Toyota & Takagi (T&T) olfactometry (four studies). A significant moderate association was found between LM and SIT‐40 (R2 = 0.612, p < 0.001) and LM and SS (R2 = 0.612, p < 0.001). An association between LM and BSIT approached significance (R2 = 0.461, p = 0.054). No significant associations were noted between LM and T&T olfactometry and between LM and SS when stratified by nasal polyp status. Conclusion: There is a significant moderate association of current CT scoring systems to SIT‐40 and SS. Further research should focus on associations of objective measures of olfaction to CT scores of the nasal cavity, sinuses, and olfactory cleft, as well as other disease markers. [ABSTRACT FROM AUTHOR]

Background: The Questionnaire of Olfactory Disorders‐Negative Statements (QOD‐NS) is a 17‐item instrument measuring olfactory‐specific quality of life (QOL). However, in clinical research patients can be overwhelmed with multiple questionnaires. We recently developed the 7‐item brief QOD‐NS (B‐QOD). Our objective was to evaluate the psychometric properties of the B‐QOD in both the development (D) sample, and in a separate replication (R) sample. Methods: Testing on D (n = 203) and R (n = 281) samples included initial exploratory factor analysis (EFA), followed by internal reliability, information loss, and confirmatory factor analysis (CFA). Finally, incremental predictive utility analysis (IPUA) was performed by correlating the B‐QOD with the 22‐item Sino‐Nasal Outcome Test (SNOT‐22) survey. Results: EFAs of both D and R demonstrated an underlying single‐factor structure (eigenvalue = 4.17 and 3.57, respectively) with comparable loading factors (R > 0.30 for both). B‐QOD also had good internal reliability in both D and R (Cronbach's alpha = 0.88 and 0.83, respectively). Also, there is minimal information loss with B‐QOD compared to QOD‐NS in both D and R (R = 0.98 and 0.96, respectively). CFA indicates that the B‐QOD single‐factor model has good overall fit as measured by the Comparative Fit Index (CFI) and the Standardized Root Mean Squared Residuals (SRMSR) in the D and R samples (CFI = 0.99 and 0.97; SRMSR = 0.035 and 0.053). IPUA shows that the QOD‐NS offers no additional predictive benefit of SNOT‐22 scores when compared with B‐QOD. Conclusion: The 7‐item B‐QOD captures a structurally coherent and reliable single dimension, with minimal information loss and excellent external predictive utility when compared to the QOD‐NS. [ABSTRACT FROM AUTHOR]

Background: Inflammatory profiles for patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) vary between North American and Asian populations. An elevated ethmoid‐to‐maxillary (E/M) opacification ratio on preoperative imaging is associated with certain postoperative outcomes in Asian populations and populations that are non‒type 2 dominant. In this study we explore this factor in North American/type 2‒based populations. Methods: Adult patients (n = 165) from a North American population with CRSwNP who underwent endoscopic sinus surgery (ESS) were prospectively enrolled into an observational, multi‐institutional study. The 22‐item Sino‐Nasal Outcome Test (SNOT‐22), Brief Smell Identification Test (BSIT), and Lund‐Kennedy (LK) endoscopic scores were obtained pre‐ and postoperatively. Patients were stratified according to increasing E/M ratios based on Lund‐Mackay (LM) scores. Results: On average, significant within‐subject postoperative improvement was found in all patients for SNOT‐22 total and domain scores, and also BSIT results (p ≤ 0.019). Preoperatively, elevated E/M ratio correlated with worse BSIT scores (r = −0.343, p < 0.001). Postoperatively, elevated E/M ratio correlated with BSIT improvement (r = 0.284, p = 0.002), but did not correlate with SNOT‐22 improvement or polyp recurrence. An elevated E/M ratio was associated with greater likelihood of reporting a minimal clinically important difference in BSIT scores (χ2 = 9.96, p = 0.041). Conclusion: Elevated E/M ratios were found to associated with worse baseline olfaction and an increased likelihood of achieving a clinically meaningful postoperative improvement in olfaction in this North American population with CRSwNP. Elevated E/M ratios did not predict postoperative changes in SNOT‐22 measures or polyp recurrence. This suggests that prognostic factors may vary according to geography and generalized inflammatory profiles (type 2 vs non‒type 2) in patients with CRS. [ABSTRACT FROM AUTHOR]

Background: Post‐viral olfactory dysfunction (PVOD) is one of the most common causes of olfactory loss. Despite its prevalence, optimal treatment strategies remain unclear. This article provides a comprehensive review of PVOD treatment options and provides evidence‐based recommendations for their use. Methods: A systematic review of the Medline, Embase, Cochrane, Web of Science, Scopus, and Google Scholar databases was completed according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Studies with defined olfactory outcomes of patients treated for PVOD following medical, surgical, acupuncture, or olfactory training interventions were included. The Clinical Practice Guideline Development Manual and Conference on Guideline Standardization (COGS) instrument recommendations were followed in accordance with a previously described, rigorous, iterative process to create an evidence‐based review with recommendations. Results: From 552 initial candidate articles, 36 studies with data for 2183 patients with PVOD were ultimately included. The most common method to assess olfactory outcomes was Sniffin' Sticks. Broad treatment categories included: olfactory training, systemic steroids, topical therapies, a variety of heterogeneous non‐steroidal oral medications, and acupuncture. Conclusion: Based on the available evidence, olfactory training is a recommendation for the treatment of PVOD. The use of short‐term systemic and/or topical steroids is an option in select patients after careful consideration of potential risks of oral steroids. Though some pharmacological investigations offer promising preliminary results for systemic and topical medications alike, a paucity of high‐quality studies limits the ability to make meaningful evidence‐based recommendations for the use of these therapies for the treatment of PVOD. [ABSTRACT FROM AUTHOR]

Background: Genetic variation of the bitter taste receptor T2R38 has been associated with recalcitrant chronic rhinosinusitis (CRS). Specific T2R38 polymorphisms, correlating with bitter taste sensitivity to phenylthiocarbamide (PTC), have been identified as an independent risk factor for surgical intervention in CRS patients without polyps; however, the exact role of PTC tasting ability in clinical practice remains unknown. In this investigation we characterize PTC taste sensitivity in a tertiary care rhinology practice with pertinent clinical measures of disease and quality of life (QOL). Methods: Adult CRS patients were prospectively assessed for their ability to taste PTC and categorized as nontasters, tasters, or supertasters. Objective taste was assessed with strips for bitter, sweet, sour, and salty, whereas olfactory testing was measured with Sniffin’ Sticks. Correlation was performed between PTC tasting ability and patient demographics, endoscopy scores, validated QOL surveys, and both subjective and objective measures of taste and olfaction. Results: Sixty‐seven patients were enrolled. Fifty‐two percent were identified as nontasters, 34% as tasters, and 13% as supertasters. Nontasters were more likely to be non‐Hispanic (p = 0.018), white (p = 0.027), without nasal polyposis (p = 0.004), and nonasthmatics (p = 0.019). There were no other statistical differences in patients’ demographics, QOL measures, and subjective or objective olfactory and taste scores when compared with patients’ oral PTC‐sensing ability. Conclusion: Oral PTC‐sensing ability may serve as a convenient marker of increased disease severity in white CRS patients without polyps and vary among regional populations. PTC tasting ability appears to provide unique phenotypic information not obtained using other subjective or objective measures of smell and taste. [ABSTRACT FROM AUTHOR]

Previous studies on the relationship between olfaction and depression have revealed mixed results. In addition, few have focused on the reciprocity of this association. The aim of this study is to combine depression and olfactory data in two separate patient populations to further understand their association. A systematic literature review was conducted using 3 online databases to identify studies correlating olfaction and depression in patients presenting with either primary depression or primary olfactory dysfunction. For the depressed population, weighted means and standard deviations for the Sniffin' Sticks Test and the 40-item Smell Identification Test were combined using 10 studies. For the olfactory dysfunction population, weighted means of Beck's Depression Inventory were combined using 3 studies. Independent t-tests were used to compare differences between groups. Comparing primary depressed patients with controls, depressed patients showed decreased scores in olfactory threshold (6.31 ± 1.38 vs. 6.78 ± 0.88, P = 0.0005), discrimination (12.05 ± 1.44 vs. 12.66 ± 1.36, P = 0.0073), identification (12.57 ± 0.74 vs. 12.98 ± 0.90, P < 0.0001), and 40-Item Smell IdentificationTest (35.31 ± 1.91 vs. 37.41 ± 1.45, P < 0.0001). In patients with primary olfactory dysfunction, Beck's Depression Inventory scores were significantly different between patients classified as normosmics, hyposmics and anosmics (5.21 ± 4.73 vs. 10.93 ± 9.25 vs. 14.15 ± 5.39, P ≤ 0.0274 for all 3 comparisons). In conclusion, patients with depression have reduced olfactory performance when compared with the healthy controls and conversely, patients with olfactory dysfunction, have symptoms of depression that worsen with severity of smell loss. [ABSTRACT FROM AUTHOR]

Background Olfactory loss is a cardinal symptom of chronic rhinosinusitis (CRS) and affects 40% to 80% of patients. However, common sinus-specific quality-of-life (QOL) instruments include only single questions related to olfaction. Few studies have explored olfactory outcomes after surgery utilizing validated, olfaction-specific QOL questionnaires. Methods Patients with CRS were enrolled from 3 centers across North America into a prospective cohort study. Patients completed the short modified version of the Questionnaire of Olfactory Disorders (QOD-NS) and the 40-item Smell Identification Test (SIT-40) before and at least 6 months after endoscopic sinus surgery (ESS). Multivariate linear regression was used to determine whether specific demographic, comorbidity, or disease severity measures were independently associated with QOD scores at baseline or predicted change after surgery. Results A total of 121 patients, equally split between genders, were enrolled with an average age of 47.9 years (range, 18-80 years). Baseline total QOD-NS scores were significantly associated with SIT-40 scores, with a moderate strength of correlation ( Rs = 0.400; p < 0.001). The average QOD-NS score improved after ESS (35.7 ± 13.0 vs 39.7 ± 12.2; p = 0.006). Allergy, polyps, and steroid-dependent conditions were found to be independently associated with worse preoperative QOD-NS scores, whereas septal deviation was associated with better QOD-NS scores. Baseline computed tomography (CT) scores were the only variable that significantly predicted change in QOD-NS after surgery. Conclusion Olfaction-specific QOL is worse in patients with polyps and comorbid allergy. Significant improvements in olfaction-specific QOL are seen after ESS, with the greatest gains seen in those with worse CT scores at baseline. [ABSTRACT FROM AUTHOR]

Background Evidence comparing the impact of medical and surgical management of chronic rhinosinusitis on olfactory function is limited. This study evaluates olfactory outcomes in patients who failed initial medical management and elect either continued medical management or endoscopic sinus surgery (ESS) followed by medical management. Methods Adult subjects were prospectively enrolled into a nonrandomized, multi-institutional cohort. Baseline characteristics, quality-of-life and objective clinical findings were collected along with 2 quality-of-life disease-specific measures, the Rhinosinusitis Disability Index (RSDI) and Sinonasal Outcome Test (SNOT-22). The primary outcome measure was the posttreatment change (≥6 months) in the Brief Smell Identification Test (B-SIT). Bivariate and multivariate analyses compared B-SIT changes by treatment type while controlling for baseline cofactors. Results Subjects (n = 280) were enrolled between March 2011 and May 2013. Baseline B-SIT scores (mean ± standard deviation) were comparable between medical and surgical treatment groups (8.8 ± 3.2 vs 9.0 ± 3.2; p = 0.703). Subjects with baseline impaired olfaction (n = 83; 29.6%) experienced B-SIT improvement in both the medical (n = 17; 2.3 ± 2.8; p = 0.005) and surgical (n = 66; 2.1 ± 3.0; p < 0.001) cohort. A total of 38.6% of subjects with impaired olfaction return to normal olfaction at follow-up with no difference identified between treatment modalities ( p = 0.803). Multivariate analyses identified prior surgery as a predictor of less improvement regardless of treatment modality in patients with baseline impaired olfaction. Average changes in B-SIT scores were comparable between treatment groups ( p > 0.050). Conclusion Subjects electing ESS experienced gains in olfaction comparable to subjects electing continued medical management. Further study with larger sample size and more sensitive measures of olfaction are needed to determine differences between treatment groups. [ABSTRACT FROM AUTHOR]